Provider Demographics
NPI:1174696629
Name:GREENBAUM-MAYA, KAREN (PH D)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:GREENBAUM-MAYA
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-0601
Mailing Address - Country:US
Mailing Address - Phone:909-626-1157
Mailing Address - Fax:909-626-4989
Practice Address - Street 1:3628 LYNOAK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3243
Practice Address - Country:US
Practice Address - Phone:909-626-1157
Practice Address - Fax:909-626-4989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 08988Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST